Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study
<i>Background & Objectives</i>: To explore the potential association between positive ANA serology and all-cause mortality in a large cohort of patients, including those with and without rheumatological conditions and other immune-related diseases. <i>Material and Methods</i...
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2025-01-01
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| author | Uria Shani Paula David Ilana Balassiano Strosberg Ohad Regev Mohamad Yihia Niv Ben-Shabat Dennis McGonagle Orly Weinstein Howard Amital Abdulla Watad |
| author_facet | Uria Shani Paula David Ilana Balassiano Strosberg Ohad Regev Mohamad Yihia Niv Ben-Shabat Dennis McGonagle Orly Weinstein Howard Amital Abdulla Watad |
| author_sort | Uria Shani |
| collection | DOAJ |
| description | <i>Background & Objectives</i>: To explore the potential association between positive ANA serology and all-cause mortality in a large cohort of patients, including those with and without rheumatological conditions and other immune-related diseases. <i>Material and Methods</i>: A retrospective cohort study analyzed all-cause mortality among 205,862 patients from Clalit Health Services (CHS), Israel’s largest health maintenance organization (HMO). We compared patients aged 18 and older with positive ANA serology (n = 102,931) to an equal number of ANA-negative controls (n = 102,931). Multivariable Cox regression models were used to assess hazard ratios (HR) for mortality, adjusting for demographic and clinical factors. <i>Results</i>: ANA positivity was strongly associated with increased mortality (adjusted HR [aHR] 4.62; 95% CI 4.5–4.7, <i>p</i> < 0.001). Significant predictors of mortality included male gender (39.2% vs. 24.4%, <i>p</i> < 0.001), older age at testing (72.4 ± 13.0 vs. 50.1 ± 17.3 years, <i>p</i> < 0.001), and Jewish ethnicity (89.6% vs. 83.2%, <i>p</i> < 0.001). Certain ANA patterns, such as mitochondrial (and dense fine speckled (DFS-AC2)), were highly predictive of mortality, with aHRs of 36.14 (95% CI 29.78–43.85) and 29.77 (95% CI 26.58–33.34), respectively. ANA-positive patients with comorbid rheumatological immune-related disorders (RIRDs) demonstrated a higher survival rate compared to those without such a condition (aHR 0.9, 95% CI 0.86–0.95, <i>p</i> < 0.001). This finding remained significant after adjusting for several parameters, including age. <i>Conclusions</i>: ANA positivity is associated with increased all-cause mortality, particularly in individuals without rheumatologic disorders, after adjusting for confounders such as age. This may indicate occult malignancies, cardiovascular pathology, or chronic inflammatory states, necessitating more vigilant surveillance |
| format | Article |
| id | doaj-art-d25d2e723a284672a3015ecced5b9ce5 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-d25d2e723a284672a3015ecced5b9ce52025-01-24T13:40:25ZengMDPI AGMedicina1010-660X1648-91442025-01-016116010.3390/medicina61010060Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based StudyUria Shani0Paula David1Ilana Balassiano Strosberg2Ohad Regev3Mohamad Yihia4Niv Ben-Shabat5Dennis McGonagle6Orly Weinstein7Howard Amital8Abdulla Watad9Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5262100, IsraelDepartment of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5262100, IsraelDepartment of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5262100, IsraelSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, IsraelSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, IsraelDepartment of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5262100, IsraelSection of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UKClalit Health Services, Tel-Aviv 4933355, IsraelDepartment of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5262100, IsraelDepartment of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5262100, Israel<i>Background & Objectives</i>: To explore the potential association between positive ANA serology and all-cause mortality in a large cohort of patients, including those with and without rheumatological conditions and other immune-related diseases. <i>Material and Methods</i>: A retrospective cohort study analyzed all-cause mortality among 205,862 patients from Clalit Health Services (CHS), Israel’s largest health maintenance organization (HMO). We compared patients aged 18 and older with positive ANA serology (n = 102,931) to an equal number of ANA-negative controls (n = 102,931). Multivariable Cox regression models were used to assess hazard ratios (HR) for mortality, adjusting for demographic and clinical factors. <i>Results</i>: ANA positivity was strongly associated with increased mortality (adjusted HR [aHR] 4.62; 95% CI 4.5–4.7, <i>p</i> < 0.001). Significant predictors of mortality included male gender (39.2% vs. 24.4%, <i>p</i> < 0.001), older age at testing (72.4 ± 13.0 vs. 50.1 ± 17.3 years, <i>p</i> < 0.001), and Jewish ethnicity (89.6% vs. 83.2%, <i>p</i> < 0.001). Certain ANA patterns, such as mitochondrial (and dense fine speckled (DFS-AC2)), were highly predictive of mortality, with aHRs of 36.14 (95% CI 29.78–43.85) and 29.77 (95% CI 26.58–33.34), respectively. ANA-positive patients with comorbid rheumatological immune-related disorders (RIRDs) demonstrated a higher survival rate compared to those without such a condition (aHR 0.9, 95% CI 0.86–0.95, <i>p</i> < 0.001). This finding remained significant after adjusting for several parameters, including age. <i>Conclusions</i>: ANA positivity is associated with increased all-cause mortality, particularly in individuals without rheumatologic disorders, after adjusting for confounders such as age. This may indicate occult malignancies, cardiovascular pathology, or chronic inflammatory states, necessitating more vigilant surveillancehttps://www.mdpi.com/1648-9144/61/1/60anti-nuclear antibodymortalityautoimmunityautoinflammatory |
| spellingShingle | Uria Shani Paula David Ilana Balassiano Strosberg Ohad Regev Mohamad Yihia Niv Ben-Shabat Dennis McGonagle Orly Weinstein Howard Amital Abdulla Watad Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study Medicina anti-nuclear antibody mortality autoimmunity autoinflammatory |
| title | Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study |
| title_full | Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study |
| title_fullStr | Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study |
| title_full_unstemmed | Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study |
| title_short | Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study |
| title_sort | mortality in antinuclear antibody positive patients with and without rheumatologic immune related disorders a large scale population based study |
| topic | anti-nuclear antibody mortality autoimmunity autoinflammatory |
| url | https://www.mdpi.com/1648-9144/61/1/60 |
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